Geographical distribution of surgical capabilities and disparities in the use of high-volume providers: the case of coronary artery bypass graft.

Department of Public Health, Division of Health Policy, Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA.
Medical care (Impact Factor: 2.94). 08/2009; 47(7):794-802. DOI: 10.1097/MLR.0b013e31819a594d
Source: PubMed

ABSTRACT Previous studies have documented substantial differences by patient race/ethnicity and insurance in the use of high-volume surgical providers. The extent to which regional availability of surgical capabilities explains such differences has not been examined.
To examine the existence of racial/ethnic and payer differences in using high-volume hospitals and surgeons for coronary artery bypass graft (CABG) in the state of Florida and to study the role of regional availability of high-volume providers in explaining the differences.
We conducted descriptive analysis of the distribution of CABG providers and patient populations by race/ethnicity and insurance across the 19 Hospital Referral Regions (HRRs) in Florida. We estimated logistic regressions of using a high-volume provider to derive estimates of overall group differences. We further estimated models with HRR fixed effects to derive within-HRR differences. We derived implications by comparing findings based on the 2 sets of models.
Non-Hispanic black patients were 58% as likely (95% CI: 52%, 65%), Hispanic patients were 84% as likely (95% CI: 77%, 90%), to have received CABGs at a high-volume hospital, compared with non-Hispanic whites. Controlling for inter-HRR differences eliminated almost all racial/ethnic differences. Substantial differences in using high-volume providers existed between Medicaid/uninsured and privately insured patients and such differences persisted within HRRs.
Unequal distribution of CABG capabilities coupled with racial/ethnic concentration in residence across Florida HRRs accounted for almost all racial/ethnic differences in using high-volume hospitals. Factors other than availability of surgical resources were responsible for differences between Medicaid/uninsured and privately insured patients.

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